Provider Demographics
NPI:1154380202
Name:WILSON, CYNTHIA GAIL (LPN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GAIL
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 SMYTH AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601
Mailing Address - Country:US
Mailing Address - Phone:330-821-3234
Mailing Address - Fax:
Practice Address - Street 1:383 SMYTH AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601
Practice Address - Country:US
Practice Address - Phone:330-821-3234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN073312164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2273454OtherINDEPENDANT PROVIDER